CABG Should Be a Subspecialty.

Subspecialization in surgery is increasingly common and for great reasons. Over the past twenty years, there is evidence in support of link between sub-specialization in the disciplines of orthopedic surgery, general, thoracic surgery, neurosurgery, and in interventional cardiology and better patient outcomes and technical advances in their respective fields. In addition, studies suggest increased hospital and surgeon volume throughout surgery may lead to improved surgical outcomes. The degree of specialization has been shown to reduce operative mortality in a variety of procedures and highlights that the level of sophistication and fund of knowledge required within each area is so great that no one surgeon can "do it all" and do it well. Cardiac surgery has become more subspecialized; however, many still view coronary artery surgery as a generalist procedure. There is debate as to the relative contribution of hospital volume, surgeon volume or degree of specialization on perioperative mortality following isolated CABG. In this paper we will discuss the current data supporting the need for specialization in coronary surgery and present arguments in favor of further specialization in this field.